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目的探求年龄超过75岁的肝细胞癌能否通过肝切除术获益。方法 2007年1月至2011年1月间796例肝细胞癌进行了根治性肝切除术。68例年龄超过75岁的病人定为高龄病人组,从剩余的728例病人中随机选择500例(年龄小于75岁)作为对照组,两组的临床病理资料和肝切除术后的结果进行了比较。结果同对照组相比较,高龄病人具有较高的丙型肝炎病毒(hepatitis C virus,HCV)感染发生率(P<0.001),较多的术前基础病,如:高血压(P<0.001)和冠心病(P<0.001),较少的术中出血(P<0.001)和较高的术后肺部感染发生率(P<0.001),两组其他术后并发症发生率和手术期病死率差异无统计学意义。高龄病人的总体生存率显著低于对照组(P=0.022);但无病生存率两组相比差异无统计学意义(P=0.095)。多因素分析表明,较高的术前甲胎蛋白(AFP)水平和较大的肿瘤直径是影响高龄病人总体生存期和无瘤生存期的独立危险因素。结论尽管总体生存率高龄组较对照组差,但术后无瘤生存率两组比较差异无统计学意义。对于年龄大于75岁的肝细胞癌病人来说,年龄本身不是肝切除术的禁忌证。经过选择的高龄病人可以通过肝切除术获得一定的治疗效果。
Objective To explore the possibility of hepatocellular carcinoma over 75 years of age by liver resection. Methods From January 2007 to January 2011, 796 cases of hepatocellular carcinoma underwent radical hepatectomy. Sixty-eight patients older than 75 years old were enrolled as elderly patients and 500 patients (aged <75 years) were randomly selected from the remaining 728 patients as control group. The clinical and pathological data and post-hepatectomy results Compare Results Compared with the control group, the elderly patients had a higher incidence of hepatitis C virus infection (P <0.001), and more preoperative basic diseases such as hypertension (P <0.001) (P <0.001), less intraoperative hemorrhage (P <0.001), and higher incidence of postoperative pulmonary infection (P <0.001). The incidence of other postoperative complications and surgical mortality in the two groups No significant difference in rates. The overall survival rate of elderly patients was significantly lower than that of the control group (P = 0.022). However, there was no significant difference in disease-free survival between the two groups (P = 0.095). Multivariate analysis showed that higher preoperative AFP level and larger tumor diameter were independent risk factors for overall survival and tumor-free survival in elderly patients. Conclusion Although the overall survival rate of the elderly group is worse than that of the control group, the postoperative tumor-free survival rate was no significant difference between the two groups. For patients with hepatocellular carcinoma older than 75 years, age alone is not a contraindication to liver resection. After the choice of elderly patients can obtain a certain degree of therapeutic effect by hepatectomy.